General Dentistry - David B. Miller D.D.S.

916-786-4865 Advanced Dental Concepts 916-786-4865

NOTICE: ANY BEFORE OR AFTER PICTURES OR PHOTOGRAPHS ARE MERELY EDUCATIONAL AND ILLUSTRATIVE IN NATURE AND NOT MEANT TO PROMISE A PARTICULAR RESULT.

Aside from accidents, the three major ways that adults lose teeth are:

1. Periodontal Disease (gum and bone infections)

2. Dental Caries (tooth decay)

3. Occlusal Problems (bad bite)

Periodontal disease is the leading cause of tooth loss among American adults and is the most common disease in the world. It is an infection of the gums, and ultimately the bone, caused by bacteria that have become embedded around the roots of teeth. This bacterial infection causes the gums to become swollen, tender and inflamed; and causes separation of the gums from the teeth creating gum pockets. This infection of the gum and bone results in destruction of the bone that holds the teeth in place and ultimately can result in the loss of teeth.

Dental Caries is also caused by bacteria. Decay starts on the surface of a tooth, but eventually penetrates the enamel (outer layer) of the tooth. After the enamel is penetrated, the bacteria enter the dentin (inner layer) of the tooth. Here the decay grows and spreads like a cancer, ultimately destroying the tooth. This widespread tooth destruction occurs because the dentin is composed of material that is very vulnerable to the bacteria. Because dentin is more susceptible to bacteria breakdown, the decay can spread very rapidly. Decay also occurs extensively around old fillings that are deteriorating and allowing leakage to occur. When this leakage occurs between the tooth and the filling, the bacteria are allowed an easy entrance to the underlying tooth structure. This is especially dangerous because the environment around and under the filling is the perfect incubator for growing the germs. Mercury/silver amalgam fillings are especially susceptible to leakage and decay. Further, the amalgam hides the decay on the x-rays until the decay is advanced.

Decay requires the removal of the infected tooth structure and placement of a dental restoration. The four basic types to single tooth restorations are: Fillings, Inlays, Onlays and Crowns. If the tooth decay gets too deep, it can infect the nerve of the tooth cause the tooth to abscess. If this happens, the only treatment options are extraction of the tooth or root canal therapy.

[top]

If a tooth is lost, we may recommend replacement with a Fixed Bridge. A bridge spans a space where one or more teeth have been lost. It is called "fixed" because it is cemented into place and does not come out. The teeth on either end of the span are crowned and called "abutments". The false tooth (teeth) spanning the gap between the crown abutments are "pontics" When a tooth or teeth are lost, the neighboring teeth are affected. Because the support and chewing forces are altered, the remaining teeth will begin to shift. The tooth opposite the missing tooth will begin to drift out of its socket. This can accelerate gum disease and occlusal disease causing further breakdown in the dental arch.

Therefore, we recommend replacing missing teeth to:

Restore and maintain the natural bite

Prevent unnatural stress on other teeth

Keep opposing teeth in their proper place

Prevent shifting and tilting of adjacent teeth

Help prevent further dental decay and gum disease

Maximize your smile, speech and chewing

Fixed bridgework is very predictable, simple, esthetic and proven method to replace missing teeth. Fixed bridges look, feel, and function like natural teeth.

If there are multiple missing teeth, missing teeth on both sides of an arch, and/or there is no anchor at one end of the span, a Removable Partial Denture may be recommended. Partial dentures (partials) use a metal framework to support denture tooth replacements of the missing teeth. Partials are not as well accepted as bridgework by patients, but function acceptably for most patients. While a traditional partial denture is secured by finger-like metal clasps around the outside of the remaining teeth, there are many options for more natural "hidden" methods of retaining the partial denture. The options available depend on the individual custom design of the partial denture.

Unfortunately some patients loose all of there natural teeth and must wear full dentures. Modern esthetic materials combined with thorough knowledge and experience in denture design and the biomechanical functional demands on dentures means that today’s dentures can work better than ever. Unfortunately, many denture patients have lost bone support on the dental ridges causing a loss of lower facial dimension, an increase in facial wrinkles and a patient who looks older than their age. Combined with the loss of bone support often comes excess wear on the old denture teeth. These flat, smooth teeth can not chew properly, often condemning the denture patient to a diet of softer, more refined, less nutritious foods at precisely the time of life when diet is most important. These patient often complain of having "lost" their bite, so there is no natural, comfortable place for the teeth and jaws to fit together. Fortunately, a patient’s bite, facial dimension and function can be restored.

[top]

Our practice is uniquely equipped to address these problems! The advanced computerized diagnostic jaw and muscle-tracking equipment that we use in the treatment of TMJ can be used to help suffering denture wearers. This equipment, in combination with years of denture experience, allows an exceptionally high success rate in "problem denture" cases. Denture patients no longer need to suffer from loose, uncomfortable and ill-fitting dentures.

Occlusal Disease or bite problems occur when the teeth do not fit together as they close together. If the teeth do not hit or mesh together correctly, one or more of the following can happen: (1) The teeth will get loose (like rocking a fence post in the ground). This can cause the loss of the tooth directly or indirectly by making the tooth more susceptible to gum disease and bone loss in the presence of periodontal disease. (2) The teeth will eventually break, especially if they have large fillings that weaken them. Mercury/silver filling material expands over time and actually causes fractures of otherwise healthy and normal tooth structure. (3) The teeth will wear down (sometimes clear to the gum) or may cause damage to the jaw joints (TMJ) and cause head pain or headaches. (4) Continued excess forces on teeth can cause chronic inflammation of the pulp (nerve) tissue. This can be present itself as sensitive teeth, either a single tooth or an entire mouth may be affected. The accumulated trauma to the teeth can cause the nerve tissue to die. The necrotic (dead) nerve tissue is then like gangrene and can spread into the bone around the end of the tooth. The only treatment available at this point is extraction or root canal therapy.
Treatment of Occlusal Disease: Treat of bite problems is specific to the individual. Occlusal problems may be solved as simply as shaving off some enamel from a single sensitive tooth to relieve excess pressure. Other patient may require full mouth reconstructive dentistry or orthodontics. Often treatment consists of the fabrication of a nightguard, a plastic mouthpiece worn at night or during periods of extreme stress. Since the plastic of the mouthpiece is softer than the enamel of the teeth, the nightguard will wear and not your teeth.

With few exceptions, these three causes of tooth loss do not cause pain until damage has become extensive. This is the one major reason why we recommend periodic check ups in our practice. We know that it is in our patients’ best interests to detect and treat problems early in their development. Treatment is less complicated, less time-consuming, and less expensive when treated early.

Our dental practice offers a comprehensive range of services for adults and children. Some of the advanced services we provide are unique in the greater Sacramento area. We refer to some of the best specialists in the Sacramento area when necessary. Knowing when to refer patients is an important skill based on knowledge, experience and the self-confidence to ask for help when it is needed. Our primary goal is to provide our patients with the best care that we can deliver.

[top]

Checklist for Dental Problems:

A positive answer to any of the following questions could indicate a serious dental problem. Please see a dentist right away to have the condition evaluated.

Do you gums bleed when you brush? (Even a little bleeding is not normal!)
Are your gums red, swollen or tender?
Do you have persistent bad breath or a bad taste in your mouth?
Do have teeth that are loose or are developing spaces between them?
Does dental floss tear or hang up on use?
Is there any change in the way that your teeth hit together when you bite?
Do you have areas where the gums have receded or pulled away from the teeth?
Do you have a grating, clicking or popping sound in either or both jaw joints when you open, close or chew?
Do you clench you teeth during the day or grind your teeth at night?
Are you teeth sensitive to hot/cold, pressure or sweets?

The Best Way to Start:

We always recommend a comprehensive examination for all of our new patients. A thorough examination allows us to detect problems at the earliest possible stage. While most people are aware that we check for cavities, that is only a small part of our "27-step New Patient Examination". To see what a "comprehensive examination" consists of go to the "New Patient" section.

[top]